When A Fall Isn't Just a Fall: Delayed Diagnosis of Acquired Hemophilia A in a Nonagenarian Patient.
Swati Gobhil, Arjun Khunger, Prajeesh Kandoth Karerat
✦ AI-curated · Sources linked
Case in brief
A 92-year-old woman presented with severe right lower extremity pain after recurrent ground-level falls. Imaging revealed bilateral lower extremity intramuscular hematomas. Initial management of her falls did not include coagulopathy evaluation. Prolonged activated partial thromboplastin time (aPTT) during her admission led to the diagnosis of acquired hemophilia A, which was treated with bypassing agents, corticosteroids, rituximab, cyclophosphamide, and emicizumab.
What made this case unusual
The case illustrates the delayed diagnosis of acquired hemophilia A in a nonagenarian, where recurrent falls were misattributed to common causes rather than an underlying coagulopathy.
Diagnostic / clinical pearl
Clinicians should consider evaluating for coagulopathy in elderly patients with recurrent or disproportionate hematomas following minor trauma, especially in the absence of anticoagulant therapy.
Why it matters
This case underscores the importance of basic coagulation testing in older adults presenting with unexplained bleeding or hematomas, which can lead to timely diagnosis and management of serious conditions like acquired hemophilia A.